Another Diabetic Miniature Schnauzer

[djalbo]

I too have a miniature schnauzer named Cooper (about 11 1/2 years old) who suddenly lost his eyesight in March of 2016 and has been recently diagnosed with diabetes (glucose 541 in early December) after he got very skinny even though he was eating and drinking water excessively.

We've been trying Vetsulin for Cooper for the past month without much success and upped his dosage to 5 IU's twice a day. At that point, we thought maybe he had Cushings disease as well and and did a Low Dose Dexamethasone Suppression (LDDS) test. His results came back 5.6 on the initial sample, 4.1 on the 4-hour sample and <1.0 on the 8-hour sample. Though the 8-hour sample looked good from what I read, my vet still seemed to think that Cooper was a Cushings dog and we started him on Trilostane a week ago (though lowered the Vetsulin shots to 3 IU's twice a day).

I'm writing all this because nothing seems to be helping Cooper at this stage and when I read your link (endocrinevet) regarding how mini schnauzers might have unusual responses to insulin and as well as Cushings tests, I was hoping for some direction or words of advice. Thank you in advance for any suggestions, Douglas.

[k9diabetes]

Re: Another Diabetic Miniature Schnauzer

Hi Douglas,

Five units of insulin doesn't sound like a very large dose so it seems to me that saying Cooper is insulin resistant and therefore possibly has Cushing's disease would be premature unless he is a very very tiny dog.

The most commonly accepted definition of "insulin resistant" is a dog who is being given 1 unit per pound and still has poorly controlled blood sugar.

Unfortunately, some vets impose inappropriately low limits on the insulin dose and thus jump to Cushing's.

So that's my first thought is that Cooper might just need more insulin than he's been getting.

How much does he weigh?

Then add in the triglycerides likely in a mini Schnauzer and you have another reason to consider the possibility that he does not have Cushing's disease but rather high blood sugar related to high triglycerides.

I have never quite gotten around to learning how to interpret the LDDS - are you a member of our sister forum for Cushing's dogs? www.k9cushings.com/forum

They could tell you whether the LDDS results fit a diagnosis of Cushing's disease.

But the blood test can't necessarily tell you whether Cushing's is present even if the results are a textbook case of positive for Cushing's.

The problem is that a body that has other concurrent illnesses, such as poorly controlled diabetes, can have elevated cortisol production. Which can look like Cushing's disease but not be it.

One thing that can help in a dog like Cooper is to do an ACTH Cushing's test. My understanding is that it is less likely to yield false positive results in a poorly controlled diabetic.

The other big indicator to me is the presence or lack of visible Cushing's symptoms - bony head and hips and saggy belly associated with changes in fat distribution, hair that's very thin or not growing back after being shaved.

If a diabetic dog's body doesn't physically scream "I have Cushing's disease" and there are other factors potentially involved, such as high triglycerides and poorly controlled blood sugar... AND the insulin dose has not been raised to 1 unit per pound to see if the dog just needs a higher than average dose... well, you can see where I'm going with this. I would not put a lot of trust in a Cushing's diagnosis and would not start treatment with the kinds of powerful medications used to treat the symptoms of Cushing's disease.

Even elevated liver values don't mean Cushing's. They mean the liver's unhappy, and that can occur for many reasons.

So, it has to be a big picture thing and, in my mind, unless the dog's body screams Cushing's disease, the first thing to do is up the insulin dose and find out for sure whether they are technically insulin resistant or just need more than average.

I've seen a few terriers who weighed about 24 pounds and needed 21 units of insulin per injection (twice a day). Not Cushing's - just unusual need for insulin and probably not processing it all that well.

The big thing I see with diabetic mini Schnauzers is erratic dosing. They go for months at one dose and then suddenly it's far too low or far too high. So they can be challenging to maintain in that regard.

Tell us all you can - and a photo of your dog now might also be helpful. You can email it to me at k9diabetes@gmail.com if you don't want to post it here.

Natalie

[djalbo]

Re: Another Diabetic Miniature Schnauzer

Natalie - Thank you so much for getting back to me so quickly. Your thoughts just verify what I was thinking as well. Cooper is about 15 lbs, down from about a 22 lb peak when he did have a pot belly over the last few years but appeared healthy otherwise. I first noticed something was amiss in January of 2016 when he didn't lead in our walks and he couldn't keep up with me. Over the next month, he then developed a couple bumps on his back area which I had checked out but proved to be negative. We did have blood work done at the time and he didn't show any signs of diabetes or any other warning signs and everything seemed pretty normal so I just chalked it up to a dog who was just getting older. But in the span of a few days in late February he started bumping into things and it was then that I realized he had gone blind virtually overnight.

I more or less panicked at that point and tried to learn everything I could about how this could have happened. All indications pointed towards SARDS from my online research which also pointed me to a more holistic Vet who happened to be located close by to us (we live in Sherwood, Oregon) who offered a milder version of the Plechner protocol for dogs with SARDS. Not sure if you are familiar with the so called Plechner syndrome, but its named after this controversial vet who claims he can restore sight to dogs with SARDS.

https://www.facebook.com/CUREFORSARD...CHNER/?fref=ts


The protocol (I didn't use Dr. Plechner's since it is a more aggressive steroid protocol) is suppose to address hormonal imbalances (cortisol, estrogen, etc) and hopefully restore some sight since that was the most outwardly noticeable problem for Cooper. The adapted protocol called for a combination of meds like Methylprednisolone (a steroid), Levothyroxine (for thyroid), Amlodipine (for heart) as well as vitamin supplements and a new diet. It seemed to work initially and his hormonal tests came back more in balance in June after his initial screenings and eye test in late March seemed to indicate that he had SARDS. Though Cooper seemed more energetic and healthy during this period during the summer and was down to a more lean 18 lbs, he was panting a lot from the steroids. I eventually weened him off the Methylprednisolone by fall since the steroid didn't seem to be helping him regain any sight (which was the reason why I went on the protocol in the first place) and his excessive panting got me concerned. But at this point, I pretty much accepted that he would be blind for the rest of his life and he seemed to adapt to it pretty well, all things considered, and seemed happy otherwise.

All of that changed in Nov/Dec when he got very skinny and lethargic even though he was still eating and drinking a lot. That was a big red flag to me and though his water intake had been elevated for months, he rarely had accidents in the house and never needed to go outside overnight. Now all of sudden, he needed to go outside a couple times each night and he was having accidents around the house. We eventually set him up in our garage overnight (he usually slept in my home office) so that he had water and a pee pad and so that he wouldn't keep waking us up.

I had our vet do another blood panel in early December and as I feared, it showed that he had diabetes (maybe from the steroid, which I will have to live with) and so we started him on the 3 IUs of Vetsulin. That didn't seem to work so we upped it to 5 IUs. That also didn't seem to help a whole lot so we did the Cushings test and as you know, his test results seemed inconclusive but our vet still seemed to think that Cooper was Cushingoid. Like you, I'm not convinced that he has Cushings disease and I do think your suggestions are right on. I did register over at K9Cushings.com and will post his LDDS results to see what others think but until I get a clearer picture of whether Cooper is Cushingoid, I've stopped giving him the Trilostane since it seemed to make him almost comatose and he wasn't eating at all. In fact, it go so bad earlier this week that I was making plans to put him down since I felt there was nothing else I could do. Which more or less, brought me to this forum as a last resort. And I'm glad I did. What I've done over the past 24-hours is up his Vetsulin to 7 IUs and I think it is already making a difference. He finally ate his entire bowl of his normal wet food, Natural Balance, this morning which he has not done for awhile. In fact, for the past week I had been hand feeding him cooked chicken which normally he would wolf down but would barely touch until the Trilostane would wear off it seemed.

So that's where I am at. Again Natalie, thanks for your help. I already feel a lot better about Cooper's prognosis just in the last 24-hours though as I have learned over the past year, hope and heartache seem to go hand in hand with aging, sick dogs. But I've had Cooper since he was 6 weeks old and I cannot bear to put him down without giving him every opportunity to recover. Though the rest of my family (wife and two teenage girls) don't quite understand my attachment to the little guy, I know that his eventual passing will take a little bit of me with him so I just hope to put that off for another year or longer. I will post a picture of Cooper or send one to you.

[k9diabetes]

Re: Another Diabetic Miniature Schnauzer

This article discusses the increase in drinking associated with SARDS and that some dogs with SARDS have Cushing's while others don't.

http://www.eyevet.ca/sards.html

Typically the onset of visual loss is sudden. In some cases it is noticed virtually overnight. In other cases observant owners may notice a degree of visual aberration for 5 to 10 days before complete loss of vision becomes apparent. Very typically the owners will report an often dramatic increase in drinking and appetite in the weeks before onset of visual loss. In many cases the weight will have increased in that time. Some owners report a concurrent decrease in hearing and smell.

A routine blood and urine work up in these patient may reveal changes which are suggestive of hyperadrenocorticism (Cushing's Syndrome). If these tests are followed up with specific testing for Cushing's (low dose dexamethasone suppression test, ACTH stimulation test) some cases will be confirmed as Cushingoid. These patients should be treated for their Cushing's syndrome, but this will not restore vision. The relationship between Cushing's syndrome and SARDS is not known.

Natalie

[labblab]

Re: Another Diabetic Miniature Schnauzer

Hi Douglas, I tracked you down over here in the hope that you were indeed already a member of K9D!

For the benefit of other folks here, I want to let you know that Douglas and I have been discussing Cooper's LDDS results on the K9C forum. Cooper's LDDS result was negative for Cushing's, so I am very disturbed to discover that he has already been taking trilostane. That is an enormous worry to me and I am very relieved you've discontinued the medication! But this an enormous red flag re: your vet's treatment recommendations. Really, really huge.

I see that you reference a link that Natalie must have provided elsewhere regarding Cushing's test irregularities that may be associated with mini Schnauzers. I would love to get that link, because I am not familiar with any breed effect upon LDDS results, but I certainly find that I learn something new every day. But for now, as I say, I have no reason to think that Cooper's LDDS would support a Cushing's diagnosis.

I know I also mentioned SARDS over on K9C, and I see that you have been quite involved with that diagnosis. I am aware of, and have so many concerns about, the Plechner protocol, and I do fear it has the potential to do more damage than good. But as you say, that's all water under the bridge and we need to move forward now with the best treatment plan possible. So as I say, unless there is something about mini Schnauzers that affect LDDS results, Cooper's test was negative and he should not have been started on trilostane on the basis of that test.

On K9C, without knowing Cooper had started trilostane, I mentioned the possibility of an ACTH stimulation test as an alternative diagnostic. That same test is essential for monitoring trilostane treatment. I see Cooper has been taking the trilostane for one week. Can you tell us at what dose? Even though you've discontinued the med, it is entirely possible that his cortisol has dropped too low. An ACTH would be essential for determining if that is the case if he does not rebound behaviorally now that the med has been discontinued.

OK, I'll go ahead and close for now. But I'm very relieved you are a member here in order to get competent advice and support re: Cooper's diabetic needs.

Marianne

[k9diabetes]

Re: Another Diabetic Miniature Schnauzer

Hey Marianne! The link is to a column by Dr. Peterson regarding mini schnauzers' tendency toward high triglycerides and its effect on blood sugar, which can make it seem like they have Cushing's because the insulin dose doesn't seem to have much of an effect. So not related to testing for Cushing's.

http://endocrinevet.blogspot.com/201...edium=facebook

[labblab]

Re: Another Diabetic Miniature Schnauzer

Natalie, thanks so much! I found this part of the article to be particularly interesting and relevant to our discussion here...

When most veterinarians see a diabetic dog with suspected insulin resistance, their top list of differentials generally includes hyperadrenocorticism or Cushing's syndrome (13,14). While secondary hypertriglyceridemia, as well as insulin resistance, can develop as a result of hyperadrenocorticism, very few of the "problem diabetic" Miniature Schnauzer dogs that I see have underlying Cushing's syndrome (14). In fact, I consider hyperadrenocorticism to be a rather uncommon endocrine disorder in the Miniature Schnauzer. One must always remember that we must use caution and be careful not to make a misdiagnosis of Cushing's syndrome in these dogs, which is a common diagnostic problem in any dog with moderate to severe nonadrenal illness.

[djalbo]

Re: Another Diabetic Miniature Schnauzer

Thank you Marianne for stepping up as well. I was about to reply to you on the K9C board but then I noticed you beat me to the punch over here! So to answer your question which you already know, Yes...I was referred by Natalie.

Since you read my initial post here on K9D, you know most of what I know about SARDs, which isn't much. Though nothing was definitively diagnosed except for an eye test, all signs pointed to Cooper having SARDs. I have read many of the links you and others have so graciously provided and Natalie is correct in saying that I was referencing the link which noted that high levels of Triglycerides in Schnauzers (which Cooper has at 480 with a normal range of 29-291 mg/dl) could lead to insulin resistance which could then assume that something else like Cushings could be responsible for his condition.

I'm not sure why my vet diagnosed Cushings from Cooper's results but she did say that she sought outside help to come to that conclusion so I don't know if she feels that confident about it. But more importantly, Cooper was not reacting well to Trilostane anyway so I wasn't going to continue that treatment.

Here is where we stand now. Cooper has not shown any improvement and he really is just a shadow of himself but at least he's eating and doesn't act like he is on death's doorstep like he was on the trilostane. If he isn't sleeping, he spends a lot of time droopy headed and in more or less of a catatonic state. He still drinks a ton of water so its pretty clear his diabetes is not been addressed at all. I did up his dose to 7 IU's this morning but I don't see much difference. I also did exchange messages with my vet today as to how high I could go on the vetsulin and she said 1 unit per kilogram, so that works out to really about the 7 units max for a 15 lb dog (according to her). I'm willing to go higher if there is no improvement since the alternative is putting Cooper down so I would have nothing to lose. Is it your understanding that you can go as high as 1 unit per pound?

The other alternative is the human insulin Novolin, which I picked up a vile of today. I read recently that it was effective for another mini schnauzer owner who did not get any results from Vetsulin either so I'm hopeful that it could be a silver bullet but at this point, I'm running out of bullets. I'm tempted to try it immediately though I don't know what, if any effect there might be in switching from the Vetsulin. The vet prescribed 4 units subcutenously twice a day.

Though Cooper does not seem to be in any pain (however he does moan a lot while doing circles trying to get comfortable before going to sleep, which I have no idea what that means), he really has no quality of life either. I've basically been tending to his needs for the past 2 months much like someone who has to care for an invalid parent in their 80's. I don't want to give up on the little guy but he has to start showing some improvement soon.

[CraigM]

Re: Another Diabetic Miniature Schnauzer

Welcome to you and Cooper! Sounds like you are getting great advice from Natalie and from the folks over at k9cushings. Just hope no damage was done with the early Cushings treatment.

Are you home blood testing? There are videos on this website, and on YouTube showing how easy it can be.

Btw, we are neighbors! I'm just north of Cooper Mountain, off SW Farmington Rd. Hope you made it through the recent snow without any problems.

Craig

[CraigM]

Re: Another Diabetic Miniature Schnauzer

The other alternative is the human insulin Novolin, which I picked up a vile of today. I read recently that it was effective for another mini schnauzer owner who did not get any results from Vetsulin either so I'm hopeful that it could be a silver bullet but at this point, I'm running out of bullets. I'm tempted to try it immediately though I don't know what, if any effect there might be in switching from the Vetsulin. The vet prescribed 4 units subcutenously twice a day.

Thought I'd mention, in case you didn't know, Novolin-N (it's Novolin-N that you bought?) requires a different syringe than Vetsulin.

Vetsulin is a U-40 insulin and requires a U-40 syringe for proper measuring. Novolin-N is a U-100 insulin and requires a U-100 syringe. Did you get the Novolin-N from Walmart for $25/vial?

Craig

[labblab]

Re: Another Diabetic Miniature Schnauzer

Douglas, what dose of trilostane were you giving Cooper? Depending upon the dosage, it's possible that a week's worth of medication may have a lingering oversuppressive effect on his cortisol production. Since the medication can lower aldosterone production in addition to cortisol, the balance of potassium and sodium in Cooper's system may also be unbalanced. But it will help us to know what dose you were giving him.

As far as his insulin, I have to defer 100% to the knowledgeable folks here.

Marianne

[djalbo]

Re: Another Diabetic Miniature Schnauzer

0.13 ML orally every 12 hours though really only administered it for two days.

[labblab]

Re: Another Diabetic Miniature Schnauzer

OK, if it was only for two days, the effect should not be long lasting.

As far as dosage, though, we need to know how many mg. of trilostane were suspended in each ml. of liquid in order to make the calculation. The Rx on the bottle label should list that information.

[djalbo]

Re: Another Diabetic Miniature Schnauzer

Label says 50 mg/ml

[labblab]

Re: Another Diabetic Miniature Schnauzer

Given Cooper's weight, that would be a reasonable dose, then, if he truly was Cushinoid. But obviously you know my doubts about that.

Thanks for all this info. I'm going to step aside now, though, so you can focus on the insulin issues with the group here. I really think that needs to be your top priority. I'll keep checking back, however, to see whether anything else develops on the Cushing's front.

Marianne